Choice

So many places for learning

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7274.0/a (Published 09 December 2000) Cite this as: BMJ 2000;321:a

This week's journal illustrates how there are many places to learn. Perhaps the best place to learn is from a gifted teacher. Susan Bewley, a consultant obstetrician, describes how Fay Hutchinson, the medical director of the Brook Advisory Service, “completely changed my approach to patients” (p 1454). Dr Hutchinson asks women to insert speculums into their vaginas themselves. “Women,” she says,” know best where their vaginas are—they put tampons, fingers, and penises in.” Dr Bewley was “shocked by the strangeness of what I was seeing and the topsy-turvy relationship between doctor and patient.” But she adopted the practice. The broader point is learning how to give up control.

Another great place to learn is from another sector. Peter Tymms and Andy Wiggins describe lessons from primary schools on the use of “league tables” of performance (p 1467). English schools have them, and Scottish ones don't. English schools were more likely to concentrate on reaching their targets at the expense of other important objectives, had narrowed their curricula, and thought that the tables had increased the blame culture. Doctors, the authors suggest, should be aware of unintended consequences of league tables.

You can learn from frantic debate, and you can learn from the fact that an issue evokes frantic debate. An article that explored how male circumcision might protect against heterosexually acquired HIV infection in men evoked 50 responses, many of them heated (p 1469). Generally the respondents didn't accept this hypothesis, but the unrepentant authors point out that international organisations, including the World Health Organization, are now exploring the role of circumcision in possibly preventing HIV infection (p 1469).

Other countries are some of the best places to learn, which is one reason why we are keen to make the BMJ ever more international. Last week in the US a new drug for irritable bowel syndrome, alosetron hydrochloride, was withdrawn from the market (p 1429). The manufacturers, Glaxo Wellcome, had submitted an application for a licence in Britain but have now withdrawn it. The US has had three prescription drugs withdrawn this year, and maybe, critics say, the Food and Drug Administration is allowing unsafe drugs onto the market because of its attempt to speed up its decisions.

Finally, a Canadian inquest has now decided that five deaths out of 12 among babies undergoing cardiac surgery in a Winnipeg hospital in 1994 were preventable (p 1433). This case is similar to what happened in Bristol in England. Comparing and contrasting might produce rich lessons.

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